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Global Medical Cures™ | When Cancer Returns

Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.

Global Medical Cures™ | When Cancer Returns

1.
National Cancer Institute
U.S. Department
of Health and
Human Services
National Institutes
of Health
Support for People With Cancer
When Cancer Returns

2.
For more information . . .
This booklet is only one of many free booklets for people with cancer.
Here are some others you and your loved ones may find useful:
• Biological Therapy: Treatments That Use Your Immune System
To Fight Cancer
• Chemotherapy and You
• Eating Hints Before, During, and After Cancer Treatment
• Taking Part in Cancer Treatment Research Studies
• Pain Control
• Radiation Therapy and You
• Taking Time
• Thinking About Complementary and Alternative Medicine
• When Your Parent Has Cancer: A Guide for Teens
• When Someone You Love Is Being Treated for Cancer
• When Someone You Love Has Advanced Cancer
These booklets are available from the National Cancer Institute (NCI.)
To learn more about the specific type of cancer you have or to
request any of these booklets, visit NCI’s Web site (www.cancer.gov).
You can also call NCI’s Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237) to speak with an information specialist.

3.
When Cancer Returns
“When I found out I had cancer again,
I just felt numb. It was hard for me
to accept the news at first.
After a few weeks, though, I started
to really look at all my options
and things I could do for myself.
By doing this, it gave me back
some control.”

4.
Table of Contents
1. Adjusting to the News..........................................................................1
2. Why and Where Cancer Returns........................................................3
3. Taking Control: Your Care and Treatment.........................................4
4. Managing the Side Effects of Your Treatment...................................9
5. Your Feelings......................................................................................15
6. Setting Goals......................................................................................25
7. Family and Friends............................................................................27
8. Looking for Meaning.........................................................................31
9. A Time To Reflect...............................................................................33
10. Words To Know..................................................................................34
11. Resources . .........................................................................................37
Words that appear in bold in the text are defined in the
Words To Know section on page 34.

5.
“One minute everything was
fine, and then my doctor
dropped the bomb that
my cancer had come back.
In five short minutes, my
life had changed again.”
—Dorothy

6.
chapter 1
Adjusting to the News
Maybe in the back of your mind, you feared that your cancer might return. Now you might be
thinking, “How can this be happening to me again? Haven’t I been through enough?”
You may be feeling shocked, angry, sad, or scared. Many people have these feelings. But you
have something now that you didn’t have before—experience. You’ve lived through cancer
once. You know a lot about what to expect and hope for.
Also remember that treatments may have improved since you had your first cancer.
New drugs or methods may help with your treatment or in managing side effects.
In fact, cancer is now often thought of as a chronic disease, one which people manage
for many years.
Using This Booklet
This booklet offers some general advice as you adjust to the news that your cancer has
returned. It covers all aspects of your treatment. These include managing side effects and
symptoms, as well as seeking emotional support.
Above all else, remember that your feelings count. There is no “right” way to cope. Some
people need a lot of information. Others like a little at a time. Likewise, some sections in this
booklet may address your needs. Others may not.
n Flip through the Table of Contents to look for topics you need.
n Using this guide along with those booklets listed on the inside front cover may help you
find the information that you need.
1

7.
“I was floored. I thought
all the cancer was gone.
I was just getting back to
a normal life. I was even
more surprised that it
came back in a different
place. But I didn’t care
where it was. I just
wanted it to go away.”
—Ronald

8.
chapter 2
Why and Where Cancer Returns
When cancer comes back, doctors call it a recurrence (or recurrent cancer).
Some things you should know are:
n A recurrent cancer starts with cancer cells that the first treatment didn’t fully remove or
destroy. Some may have been too small to be seen in follow-up. This doesn’t mean that
the treatment you received was wrong. And it doesn’t mean that you did anything wrong,
either. It just means that a small number of cancer cells survived the treatment. These cells
grew over time into tumors or cancer that your doctor can now detect.
n When cancer comes back, it doesn’t always
show up in the same part of the body. For
example, if you had colon cancer, it may
come back in your liver. But the cancer is
still called colon cancer. When the original
cancer spreads to a new place, it is called a
metastasis (meh-TAS-tuh-sis).
n It is possible to develop a completely new
cancer that has nothing to do with your
original cancer. But this doesn’t happen
very often. Recurrences are more common.
Where Cancer Can Return
Doctors define recurrent cancers by
where they develop. The different
types of recurrence are:
n Local recurrence. This means
that the cancer is in the same
place as the original cancer or is
very close to it.
n Regional recurrence. This is
when tumors grow in lymph
nodes or tissues near the place
of the original cancer.
n Distant recurrence. In these
cases, the cancer has spread
(metastasized) to organs or
tissues far from the place of the
original cancer.
Local cancer may be easier to treat
than regional or distant cancer.
But this can be different for each
patient. Talk with your doctor
about your options.
3

9.
chapter 3
Taking Control: Your Care and Treatment
Cancer that returns can affect all parts of your life. You may feel weak and no longer in control.
But you don’t have to feel that way. You can take part in your care and in making decisions.
You can also talk with your health care team and loved ones as you decide about your care.
This may help you feel a sense of control and well-being.
Talking With Your Health Care Team
“I always ask lots of questions because I want to be ready just in case
something happens. I really do believe that everyone taking care of me has
my best interests at heart. But I worry that if I don’t ask about everything,
they may forget to give me the answers.” —Bonita
Many people have a treatment team of health providers who work together to help them. This
team may include doctors, nurses, oncology social workers, dietitians, or other specialists.
Some people don’t like to ask about treatment choices or side effects. They think that doctors
don’t like being questioned. But this is not true. Most doctors want their patients to be
involved in their own care. They want patients to discuss concerns with them.
Here are a few topics you may want to discuss with your health care team:
n Pain or Other Symptoms. Be honest and open about how you feel. Tell your doctors if
you have pain and where. Tell them what you expect in the way of pain relief. (See Chapter
4 for more about pain and other symptoms.)
n Communication. Some people want to know details about their care. Others prefer to
know as little as possible. Some people with cancer want their family members to make
most of their decisions. What would you prefer? Decide what you want to know, how much
you want to know, and when you’ve heard enough. Choose what is most comfortable for
you. Then tell your doctor and family members. Ask that they follow through with your
wishes.
n Family Wishes. Some family members may have trouble dealing with cancer. They don’t
want to know how far the disease has advanced. Find out from your family members how
much they want to know. And be sure to tell your doctors and nurses. Do this as soon as
possible. It will help avoid conflicts or distress among your loved ones. (See page 27 to read
more about talking with your loved ones.)
4

10.
Other Tips for Talking With Your Health Care Team
“You need a notebook because you go to the doctors and they’re telling you
things, and you’re so scared that you don’t really listen. Then you get home,
and you can’t even remember what they said.” —Jake
n Speak openly about your needs, questions, and concerns. Don’t be embarrassed to ask
your doctor to repeat or explain something.
n Keep a file or notebook of all the papers and test results that your doctor has given you. Take
this file to your visits. Also keep records or a diary of all your visits. List the drugs and tests you
have taken. Then you can refer to your records when you need to. Many patients say this is
helpful, especially when you meet with a new doctor for the first time.
n Write down your questions before you see your doctors so you will remember them.
(See the box on page 10.)
n Ask a family member or friend to go to the doctor’s office with you. They can help you ask
questions to get a clear sense of what to expect. This can be an emotional time. You may
have trouble focusing on what the doctor says. It may be easier for someone else to take
notes. Then you can review them later.
n Ask your doctor if it’s okay to tape-record your talks.
n Tell your doctor if you want to get dressed before talking
about your results. Wearing a gown or robe is distracting
for some patients. They find it harder to focus on what
the doctor is saying.
Treatment Choices
There are many treatment choices for recurrent cancer. Your
treatment will depend partly on the type of cancer and the
treatment you had before. It will also depend on where the
cancer has recurred. For example:
n A local recurrence may be best treated by surgery or
radiation therapy. This means that the doctor removes
the tumor or destroys it with radiation.
n A distant recurrence may need chemotherapy,
biological therapy, or radiation therapy. (For more
information see the NCI booklets Radiation Therapy and
You, Chemotherapy and You, and Biological Therapy.)
It’s important to ask your doctor questions about all your
treatment choices. You may want to get a second opinion as
well. You may also want to ask whether a clinical trial is an
option for you.
Should I Get A
Second Opinion?
Some patients worry that
doctors will be offended if
they ask for a second opinion.
Usually the opposite is true.
Most doctors welcome a
second opinion. And many
health insurance companies
will pay for them.
If you get a second opinion,
the doctor may agree with
your first doctor’s treatment
plan. Or the second doctor
may suggest another
approach. Either way, you
have more information and
perhaps a greater sense of
control. You can feel more
confident about the decisions
you make, knowing that
you’ve looked at your options.
5

11.
Questions to Ask
Your Doctor or Nurse
About Treatment Choices
Decide on the most important
things you need to ask your
doctor or nurse. Some ideas:
n What are my treatment
choices?
n Which do you suggest for me?
n How is this treatment the
same as or different from my
last treatment?
n How successful is the
treatment you recommend?
Why is it best for me?
n Will I still be able to do things
I enjoy with the treatment?
Without the treatment?
n How long will I be on this
treatment?
n Will I have side effects? If so,
how long will they last?
n How can I manage the
side effects?
n Will I have to stay in the
hospital?
n Is a clinical trial available
to me?
n Will I have to pay any costs in
a clinical trial?
n If the treatment doesn’t work,
then what will I do?
6
Clinical Trials
Treatment clinical trials are research studies that try
to find better ways to treat cancer. Every day, cancer
researchers learn more about treatment options from
clinical trials.
Each study has rules about who can take part. These
rules include the person’s age and type of cancer. They
also cover earlier treatments and where the cancer
has returned.
Clinical trials have both benefits and risks. Your
doctor should tell you about them before you make
any decisions about taking part.
There are different phases of clinical trials. They
include:
n Phase I trials test what dose of a treatment is safe
and how it should be given.
n Phase II trials discover how cancer responds to a
new drug or treatment.
n Phase III trials compare an accepted cancer
treatment (standard treatment) with a new
treatment that researchers hope is better.
Taking part in a clinical trial could help you and
others who get cancer in the future. But insurance and
managed care plans do not always cover the costs.
What they cover varies by plan and by study. If you
want to learn more about clinical trials, talk with your
health care team.
For more information about clinical trials, see
NCI’s brochure Taking Part in Cancer Treatment
Research Studies.

12.
Making Your Wishes Known
Legal Papers At-A-Glance
When cancer returns,
the treatment goals may
change, or they may be
the same as they were
for your first cancer.
But for many people,
it’s the second cancer
diagnosis that finally
prompts them to make their wishes known. Although it
can be tough to think about, and maybe even tougher
to talk about, having recurrent cancer may prompt you
to make certain decisions about what you want done
for you if you are unable to speak for yourself.
Advance directives
Everyone should make a will and talk about end-oflife choices with loved ones. This is one of the most
important things you can do. Also, think about giving
someone you trust some rights to make medical
decisions for you. You give these rights through legal
documents called advance directives. These papers
tell your loved ones and doctors what to do if you can’t
tell them yourself. They let you decide ahead of time
how you want to be treated. These papers may include
a living will and a durable power of attorney for
health care.
Other legal papers
that are not part of the
advance directives
Setting up an advance directive is not the same as
giving up. Making such decisions at this time keeps you
in control. You are making your wishes known for all
to follow. This can help you worry less about the future
and live each day to the fullest.
n Power of attorney appoints
a person to make financial
decisions for you when you
can’t make them yourself.
It’s hard to talk about these issues. But it often comforts
family members to know what you want. And it saves
them from having to bring up the subject themselves.
You may also gain peace of mind. You are making these
hard choices for yourself instead of leaving them to
your loved ones.
Make copies of your advance directives. Give them
to your family members, your health care team, and
your hospital medical records department. That way,
everyone will know your decisions.
n A living will lets people know
what kind of medical care
you want if you are unable to
speak for yourself.
n A durable power of attorney
for health care names a
person to make medical
decisions for you if you can’t
make them yourself. This
person is called a health
care proxy.
n A will tells how you want
to divide your money and
property among your heirs.
(Heirs are usually the family
members who survive you.
You may also name other
people as heirs in your will.)
Note: You do not always need a
lawyer present to fill out these
papers. But you may need a
notary public. Each state has
its own laws about advance
directives. Check with your lawyer
or social worker about the laws
in your state. (For more, see the
Resources on page 37.)
7

13.
“For me personally, the
challenge is not to let the
treatments get the best of me.
I make sure if I have any new
aches or pains I tell my doctor
right away. He’s great about
working with me to handle
these things.” —Edna

14.
chapter 4
Managing the Side Effects of Your Treatment
You probably already know about ways to manage the side effects of cancer treatment. If so,
parts of this section will be a review for you. It outlines some of the support therapies cancer
patients have found helpful.
For more information about side effects, see the NCI booklets Radiation Therapy and You and
Chemotherapy and You.
Comfort Care
You have a right to comfort care both during and after treatment. This kind of care is often
called palliative (PAL-ee-yuh-tiv) care. It includes treating or preventing cancer symptoms
and the side effects caused by treatment. Comfort care can also mean getting help with
emotional and spiritual problems during and after cancer treatment.
People once thought of palliative care as a way to comfort those dying of cancer. Doctors now
offer this care to all cancer patients, beginning when the cancer is diagnosed. You should
receive palliative care through treatment, survival, and advanced disease. Your oncologist
may be able to help you. But a palliative care specialist may be the best person to treat some
problems. Ask your doctor or nurse if there is a specialist you can go to.
Pain Control
Having cancer doesn’t always mean that you’ll have pain. But if you do, you shouldn’t accept
pain as normal. Your doctor can control pain with medicines and other treatments. Managing
your pain helps you sleep and eat better. It makes it easier to enjoy your family and friends,
and to focus on the things you enjoy.
Have regular talks with your health care
team about your pain. Let them know what
kind of pain it is, where it is, and how bad
it is. These talks are important because
pain can change throughout your illness.
And your pain may show where cancer has
returned after remission. Many hospitals
have doctors who are experts in treating
pain. Tell your doctor if you would like to
talk to a pain specialist.
9

15.
Controlling Pain
Treatments can be used for all types of pain,
including:
What To Tell Your Doctor
n Mild to medium pain
When describing pain to your doctor,
give as much detail as you can. Your
doctor may want to know:
n Where exactly is your pain? Does it
move from one spot to another?
n How does the pain feel—dull,
sharp, burning?
n Medium to very bad pain
n Breakthrough pain
n Tingling and burning pain
n Pain caused by swelling.
There are different ways to take pain medicine,
such as:
n By mouth
n How often do you have pain?
n Through the skin (with a patch)
n How long does it last?
n By shots
n Does it occur at a certain time of
day—morning, afternoon, night?
n Through an I.V. pump.
n What makes the pain better?
n What makes it worse?
Using Strong Drugs To
Control Pain
People with cancer often need strong
medicine to help control their pain.
Don’t be afraid to ask for pain medicine
or for larger doses if you need them.
And the drugs will help you stay as
comfortable as possible.
People with cancer hardly ever get
addicted to these drugs. Sadly, fears
of addiction sometimes prevent
people from taking medicine for pain.
The same fears also prompt family
members to encourage loved ones to
“hold off” between doses. But people in
pain get the most relief when they take
their medicines and treatments on a
regular schedule.
10
Your medicine, and how you take it, will depend
on the type of pain and its cause. For example,
for constant pain you may need a steady dose of
medicine over a long period of time. You might use
a patch placed on the skin or a slow-release pill.
You may want to keep a pain diary to help you
explain your pain to your doctor. In the diary,
write down:
n The time of day you had the pain
n What you were doing when you felt the pain
n What it felt like
n Where you felt it.
Your doctor may also ask you some questions
about how your pain affects your daily routine.
Having your pain managed means that you can
focus on living your life and not be distracted
by pain.
To learn more, see the NCI booklet Pain Control.

16.
Other Ways To Treat Pain
Cancer pain is usually treated with medicine and other therapies. But there are also some
nondrug treatments. They are types of complementary and alternative medicine (CAM).
Many people have found the methods listed below
helpful. But talk with your health care team before
trying any of them. Make sure they are safe and won’t
interfere with your cancer treatment.
n Acupuncture is a form of Chinese medicine that
stimulates certain points on the body using small
needles. It may help treat nausea and control
pain. Before using acupuncture, ask your health
care team if it is safe for your type of cancer.
n Imagery is imagining scenes, pictures, or experiences to feel calmer or perhaps to help the
body to heal.
n Relaxation techniques include deep breathing and exercises to relax your muscles.
n Hypnosis is a state of relaxed and focused attention. One focuses on a certain feeling, idea,
or suggestion.
n Biofeedback is the use of a special machine to help the patient learn how to control
certain body functions. These are things that we are normally not aware of (such as
heart rate).
n Massage therapy brings relaxation and a sense of well-being by the gentle rubbing of
different body parts or muscles. Before you try this, you need to check with your doctor.
Massage is not recommended for some kinds of cancer.
These methods may also help manage stress. Again, talk to your health care team before
using anything new, no matter how safe it may seem. Ask your health care team for more
information about where to get these treatments. To learn more, see the NCI booklet Thinking
About Complementary and Alternative Medicine.
11

17.
Fatigue
Fatigue is more than feeling tired. Fatigue is exhaustion—not being able to do even the small
things you used to do. A number of things can cause fatigue. Besides cancer treatment, they
include anxiety, stress, and changes in your diet or sleeping patterns. If you are having some of
these problems, you might want to:
n Tell your doctor or nurse at your next visit. Ask about medicines that can help with fatigue.
n Eat a well-balanced diet
n Plan your days and do only what is important to you
n Take short breaks every day to rest and relax
n Take naps
n Ask others for help.
Nausea and Vomiting
Nausea is feeling sick to your stomach. Vomiting means throwing up. Both can be a problem
for cancer patients. Untreated nausea and vomiting can make you feel very tired. They can also
make it hard to get treatments or to care for yourself. There are many drugs to help you control
nausea and vomiting. Ask your doctor which medicines might work best for you.
You also may want to make these changes to your diet:
n Eat small amounts of food five to six times a day.
n Avoid foods that are sweet, fatty, salty, spicy, or have strong smells. These may make
nausea and vomiting worse.
n Have as much liquid as possible. You’ll want to keep your body from getting too dry
(dehydrated). Broth, ice cream,
water, juices, herb teas, and
watermelon are good choices.
12

18.
Nutrition
For some patients, it’s hard to eat the foods they normally enjoy. For others, it’s hard to eat
anything at all. Are you having trouble eating or digesting food? If so, you may want to talk with
your doctor about your diet. They may suggest:
n A special diet
n Other ways of getting the nutrition you need
n Tips on eating during treatment
n Seeing a dietitian.
For more information, see the NCI booklet Eating Hints Before, During, and After
Cancer Treatment.
Sleep Problems
Illness, pain, stress, drugs, and being in the hospital can cause sleep problems. These problems
may include:
n Having trouble falling asleep
n Sleeping only for short amounts of time
n Waking up in the middle of the night
n Having trouble getting back to sleep.
To help with your sleep problem, you may want to try:
n Reducing noise, dimming lights, making the room warmer or cooler, and using pillows to
support your body
n Dressing in loose, soft clothing
n Going to the bathroom before bed
n Eating a high-protein snack 2 hours before bedtime (such as peanut butter, cheese, nuts, or
some sliced chicken or turkey)
n Avoiding caffeine (coffee, tea, cola, hot cocoa)
n Keeping regular sleep hours
n Avoiding naps longer than 15-30 minutes
n Talking with your health care team about drugs to help you sleep.
13

19.
Physical Therapy
Sometimes people with cancer feel pain in different parts of their body. Others feel weak and
tired. And some feel stiffer than they used to. So it can become hard to move different body
parts. If you are having any of these problems, your health care team may suggest you see a
physical therapist. The therapist may use heat, cold, massage, pressure, or exercises to help
you. Physical therapy may reduce tiredness and help your body function better. It may help
with strength and balance as well. It also may help with stiffness and other side effects of
radiation therapy.
Complementary and Alternative Medicine
Complementary and alternative medicine (CAM) treatment can be helpful for some people.
And some CAM treatments are safe, such as those listed for pain on p. 11. But you may have
read about different diets, vitamins, and herbs for treating your cancer or symptoms. Talk with
your health care team before you try anything new. Here’s why:
n Some CAM treatments are not proven to work and could actually harm you.
n You may have a dangerous reaction. Or the CAM treatment could interfere with the
medicine your doctor has prescribed.
n A “natural” product doesn’t mean that it’s a safe product.
Seek information about CAM treatments from trusted sources. Federal agencies and nonprofit
cancer groups are good sources. You might also want to read the NCI booklet Thinking About
Complementary and Alternative Medicine: or go to NCI’s Office of Complementary and
Alternative Medicine (www.cancer.gov/cam).
14

20.
chapter 5
Your Feelings
“Life has changed again and I can’t help feeling frustrated with all that’s
going on. One minute I’ll be upset and angry. Then the next minute, I’ll start
crying all of a sudden. I just never know what’s coming next.” —Kathy
People feel so many emotions when they find out that their cancer has come back. Shock, fear,
anger, and denial are just a few. The new diagnosis hits them as hard as it did the first time, or
even harder.
Regardless of your first reaction, starting cancer treatment again can place even more
demands on your mind and spirit. You’ll have good days and bad days. So just remember that
it’s okay to feel a lot of different emotions.
Some of these emotions may be ones you have had at other times in your life. But you may
be feeling them more intensely. If you have dealt with them in the past, you may be able to
cope with them now, too. If some of the feelings are new, or are so strong that it is hard to get
through everyday activities, you may want to ask for help.
There are many people who may be able to help you. These include health psychologists,
oncology social workers, other mental health experts, and leaders in your faith or spiritual
community. They know many ways to help you cope with your feelings. See the section on
page 21 for other ideas on how to cope.
Stress
“Once you get diagnosed again and go through more surgeries or procedures,
your life is not normal. It’s always in the back of your mind. What now?
What’s next?” —Margaret
Stress is a normal reaction to cancer. After all, you’re dealing with a lot: treatment, family, your
job, money, and day-to-day living. Sometimes, you may not even notice that you are stressed.
But your family and friends probably see a change.
Anything that makes you feel calm or relaxed may help. So try to think of things that relax you
and that you enjoy doing. Some people try deep breathing, listening to tapes that have nature
sounds, or listening to music. See page 22 for more ideas on how to relieve stress.
15

21.
Hope
“I just keep telling myself, ‘You’ve got to have hope, you’ve got to have faith,
because anything can happen.’” —Phil
While you may be sad or depressed about your cancer recurrence, you do have reasons to feel
hopeful. Science has advanced and cancer treatments have improved. So more people are
surviving cancer than ever before. Nearly 10 million people who have a history of cancer are
alive today.
In other words, cancer is becoming a disease that doctors can manage. To help build your
sense of hope:
n Plan your days as you have always done.
n Don’t limit the things you like to do just because you have cancer.
n Look for your own reasons to have hope.
Gratitude
“I do have a lot of bad days, but you know, I don’t talk about those.
I forget those. I think about all the good things, and I have a lot of nice
times when I’m with my grandchildren, when I go to church, and when
I’m with my friends.” —Helen
Some people see their cancer coming back as a “wake-up call.” They may realize the
importance of enjoying the little things in life. They go places they’ve never been. They finish
projects they had started but put aside. They spend more time with friends and family. They
mend broken relationships.
It may be hard at first, but you can find joy in your life. Take note of what makes you smile. Pay
attention to the things you do each day that you enjoy. They can be as simple as drinking your
morning coffee, sitting with a pet, or talking to a friend. These small, day-to-day activities can
give you comfort and pleasure.
You can also do things that are more meaningful to you. Everyone has special things, both
large and small, that bring meaning to their life. For you, it may be visiting a garden in your city
or town. It may be praying in a certain chapel. Or it could be playing golf or some other sport
that you love. Whatever you choose, embrace the things that bring you joy when you can.
16

22.
Anxiety
“I get overwhelmed a lot. There’s so much to deal with right now.
And I still have to deal with all the things that were going on before
I got sick again. How am I going to get to the store before it closes?
Has the dog been fed? What about the report that’s due at work?
I start to panic when I think of all the things on my plate.” —Jing
Cancer takes a toll on both your body and your mind. You are coping with so much now.
You may feel overwhelmed. Pain and medicines for pain can also make you feel anxious or
depressed. And you may be more likely to feel this way if you have had these feelings before.
Here are some signs of anxiety:
n Feeling very tense and nervous
n Racing heartbeat
n Sweating a lot
n Trouble breathing or catching your breath
n Having a lump in your throat or a knot in your stomach
n Feeling fear.
Feeling anxious can be normal. But if it begins to disrupt your daily life, tell a member of
your health care team. They can suggest someone for you to talk to. Or they can give you
medicines that will help. Some of the nondrug choices for pain may work for your anxiety
as well (see page 18).
“Every tomorrow has two handles. We can take hold of it with the handle
of anxiety or with the handle of faith.” —Henry Ward Beecher
Fear
“Honestly, I feel scared about a lot of things. Stuff I try not to think about.
It comes and goes, but there always seems to be something. Even when I’m
having good days, the fear is always in the back of my mind. It never goes
away really.” —Deena
It’s normal to feel scared and worried. You may be afraid of pain or other side effects, either
from the cancer or the treatment. You may worry about looking different as a result of your
treatment. You may worry about taking care of your family, paying your bills, and keeping your
job. You may be afraid of dying.
17

23.
Signs of Depression
n Feeling helpless or hopeless,
or that life has no meaning
n No interest in family, friends,
hobbies, or things you used
to enjoy
It’s hard to deal with the fear of so many unknowns.
Some people say it helps if you know what to expect in
the future. Ask your health care team questions, so you
can understand more about your cancer and treatment
choices. Also, update your will and other legal papers,
if you haven’t already done so. Then you won’t have to
worry about them.
n Loss of appetite
Fear can be overwhelming. Remember that others have
felt this way, too. It’s okay to ask for help.
n Feeling short-tempered
and grouchy
Sadness and Depression
n Not being able to get certain
thoughts out of your mind
n Crying for long periods of
time or many times each day
n Thinking about hurting or
killing yourself
n Feeling “wired,” having
racing thoughts or
panic attacks
n Sleep problems, such as
not being able to sleep,
having nightmares, or
sleeping too much.
“I feel sad a good bit of the time now.
One thing that cheers me up is to be with
my 4-year-old grandson. I love watching
him as he grows more and more each day.
Sometimes just thinking about him makes
me feel better.” —Pat
Sadness is a normal response to any serious illness. You
may feel sad that you have to go through treatment again.
You may feel sad that life won’t be quite the same from
now on.
It’s okay to feel blue. You don’t need to be upbeat all the
time or pretend to be cheerful. Many people say that
they want the freedom to just give in to their feelings
sometimes. But others say that it helps to look for what is
good in life, even in the bad times.
Depression can happen when sadness or despair seems
to take over your life. Some of the signs listed on the next
page are normal at a time like this. But if they last more
than two weeks, talk
to your doctor. Some
symptoms could
be due to physical
problems. This is why
it’s important to let
your doctor know
about them.
18

24.
Anger
“It challenged my faith... But I’ve come out of it okay. It was tough in the
beginning, trying to understand why this would happen to me.” —Bob
You may also feel angry or frustrated. It’s normal to ask, “Why me?” You may be mad at the
cancer, your doctors, or your loved ones. If you are religious, you might even be angry with God.
If you feel angry, it’s helpful to remember that you don’t have to pretend that everything is okay.
Try to figure out why you are angry. Anger sometimes comes from feelings that are hard to
show. These might be fear, panic, frustration, worry, or helplessness.
It’s not always easy to look at what is causing your anger. But it’s healthy to try. Being open and
dealing with your anger may help you let go of it. It’s also good to know that anger is a form of
energy. You can express this energy through exercise, art, or even just hitting the bed with a pillow.
Guilt
“I’m so tired all the time. I feel bad that my mom has to take care of me
and handle things for me like she did when I was younger. I see everything
she and Dad are dealing with, yet there’s nothing I can do about it. I know
they hate the fact that I’m going through this. I try to do what I can, but
I can’t stop feeling guilty for what they are going through, too.” —Anne
It’s normal for some people to wonder whether they did things that caused their cancer to
recur. People feel guilty for a number of reasons:
n They worry about how their family and friends feel.
n They envy other people’s good health and are ashamed of this feeling.
n They blame themselves for certain lifestyle choices.
n They feel guilty that their first treatment didn’t work.
n They wonder if they waited too long to go back to the doctor. Or they fear that they didn’t
follow the doctor’s instructions the right way.
But it’s important to remember that the treatment failed you. You didn’t fail
the treatment. We can’t know why cancer returns in some people and not others. So, it’s
important for you to try to:
n Focus on things worthy of your time and energy.
n Let go of any mistakes you think you may have made.
n Forgive yourself.
19

25.
You may want to share these feelings with your loved ones. Some people blame themselves
for upsetting the people they love or worry that they’ll be a burden to others. If you feel this
way, take comfort knowing that many family members say that it is an honor and a privilege to
care for their loved one. Many consider it a time when they can share experiences and become
closer to one another. Others say that caring for someone else makes them take life more
seriously and causes them to reevaluate their priorities.
If you don’t feel that you can talk openly about these things with your loved ones, getting
counseling or joining a support group may also help. Let your health care team know if you
would like to talk with someone about your feelings.
Loneliness
“I have lots of people around me who care, but I still feel like no one
really understands.” —Carlos
You may feel lonely, even when lots of people support and care for you. Here are some
common feelings:
n You feel like no one else understands what you’re going through, even those you love and
care about.
n You feel distant from others. Or you find that your family and friends have a hard time
dealing with your cancer.
n You realize that you aren’t able to take part in as many events and activities as you used to.
Although it may be harder some days than others, remember that you aren’t alone. Continue to
do the things you’ve always done as best you can. If you want to, tell people that you don’t want
to be alone and that you welcome their visits. More than likely, your loved ones have feelings
like yours. They may feel isolated from you
and lonely if they are unable to talk with you.
20

26.
Denial
You may feel that this is not happening to
you. It’s tough to accept that the cancer has
come back. Feeling that you need more time
to absorb everything is natural. You may need
more time to adjust to the news. But this can
become a serious problem if it lasts longer
than it should. It can keep you from getting
the treatment you need or talking about your
treatment choices. As time passes, try to keep
an open mind. Listen to what others around
you suggest for your care.
Ways You Can Cope
Your feelings will come and go, just like they
always have. If you have some strategies to
deal with them, you have already taken a step
in the right direction.
Know that many other people have been
where you are. Some do better when they join
a support group. It helps them to talk with
others who are facing the same challenges.
You may prefer to join an online support
group. That way you can chat with people
from home. Be sure to check the privacy
issues before you join.
A Word About Support Groups
You may have heard about support
groups in your area for people with
cancer. They can meet in person, by
phone, or over the Internet. They may
help you gain new insights into what’s
happening, get ideas about how to cope,
and help you know that you’re not alone.
In a support group, people may talk
about their feelings and what they have
gone through. They may trade advice and
try to help others who are dealing with
the same kinds of issues. Some people
like to go and just listen. Others prefer
not to join support groups at all. Some
people aren’t comfortable with this kind
of sharing.
If you feel like you would enjoy outside
support such as this, but can’t get to a
group in your area, try a support group
on the Internet. Some people with cancer
say that Web sites with support groups
have helped them a lot.
If support groups don’t appeal to you, there
are many experts who are trained to give
cancer support. These include oncology
social workers, psychologists or health
psychologists, counselors, or members of
your faith or spiritual community. For more
information, see the Resources section on
page 37.
What I need at least once or twice
a week is to talk to one or a group
of people who are in the same
shoes as I am.” —Vince
21

27.
Ways You Can Cope
You may be able to continue
many of your regular activities,
even though some may be more
difficult than before. Whatever
you do, remember to conserve
your strength for the things you
really want to do. Don’t plan too
many things for one day. Also try
to stagger them during the day.
Here are some things other
people with cancer say have
helped them cope. As you can
see, even the little things help!
I built a birdhouse with my
grandson. We had fun, and I loved
teaching him about tools.
Spend time with the people I love.
I watch a lot of movies.
I like to fix things around the
house.
I took up photography. I didn’t
buy a fancy camera or anything—
I just started taking pictures.
I’m taking a watercolor class. I’m awful at it, but
I sure don’t care—anything that gets my mind off
things.
I like to get my nails done.
I started to follow the stock market.
My nieces call and leave messages or songs on my
answering machine. I listen to them when I need a fast
way of cheering up.
Sometimes I drive out to the airport and watch the
planes. For some reason, it’s very soothing to me.
22

28.
Build model airplanes.
Arrange flowers.
Window shop.
People watch at the mall.
Go to a movie.
Play board games or cards.
Attend local concerts and plays.
Start a new daily routine.
Accept that it may have to be
different from your old one—
change is okay!
Talk about feelings with friends,
family, or a leader in your faith
or spiritual community.
Do exercise, yoga or gentle
stretching.
Go fishing.
Do the things I enjoy, like
making phone calls or reading.
Listen to music or a
relaxation tape.
Do woodcarving.
I like to bird-watch. I sit
on my porch with a pair
of binoculars.
Read mystery novels.
Spend time outdoors in a
community garden or park.
Volunteer or find a way to help
others in need.
Plant flowers.
Go to worship services.
Knit, crochet, or do needlepoint.
Do crossword puzzles.
Meditate or do relaxation exercises.
23

29.
“There are lots of things
I still like doing, but I know
that I can’t do them as well
or as much. But that doesn’t
stop me from trying to
achieve them in a different
way.” —Sookie

30.
chapter 6
Setting Goals
Cancer treatment can take up a lot of your time and energy. It helps to plan something that
takes your mind off the disease each day. Aim for small goals each day, such as:
n Exercising
n Completing tasks you’ve been wanting to do
n Making phone calls
n Having lunch with a friend
n Reading one chapter of a book or doing a puzzle
n Listening to music or a relaxation tape.
Many people with cancer also set longer-term goals. They say that they do much better if they
set goals or look forward to something special. It could be an anniversary, the birth of a child
or grandchild, a wedding, a graduation, or a vacation. But if you set a long-term goal, make
sure you are realistic about how you will achieve it.
Remember, too, that being flexible is important. You may have to change your plans if your
energy level drops. You may have to adjust your goals if the cancer causes new challenges.
Whatever your goals, try to spend your time in a way that you enjoy.
25

31.
“My father and I are so
much closer. It’s a totally
different family than
we were before I was
diagnosed. We’ve learned
how to talk about how
we feel, how to talk to
each other about what’s
going on and what we’re
afraid of.” —Charlie

32.
chapter 7
Family and Friends
Your loved ones may need time to adjust to the news that your cancer has returned. They need
to come to terms with their own feelings. These may include confusion, shock, helplessness,
anger, and other feelings.
Let family members and friends know that they can offer comfort just by:
n Being themselves
n Listening and not trying to solve problems
n Being at ease with you.
Knowing that they are able to comfort you may help them cope with their feelings.
Bear in mind that not everyone can handle the return of cancer. Sometimes a friend or family
member can’t face the idea that you might not get better. Some people may not know what to say
or do for you. As a result, relationships may change, but not because of you. They may change
because others can’t cope with their own feelings and pain. If you can, remind your loved ones
that you are still the same person you always were. Let them know if it’s all right to ask questions
or tell you how they feel. Sometimes just reminding them to be there for you is enough.
It’s also okay if you don’t feel comfortable talking about your cancer. Some topics are hard to
talk about with people you are close to. In this case, you may want to talk with a member of
your health care team or a trained counselor. You might want to attend a support group where
people meet to share common concerns.
Family Meetings
Some families have trouble expressing their needs to each other. Other families simply do not
get along. If you don’t feel comfortable talking with family members, ask a member of your
health care team to help. You could also ask a social worker or other professional to hold a
family meeting. This may help family members feel that they can safely express their feelings.
It can also be a time for you and your family to meet with your entire health care team to solve
problems and set goals. Although it can be very hard to talk about these things, studies show
that cancer care is a smoother process when everyone remains open and talks about the issues.
“It’s a roller coaster ride, so we just ride the roller coaster. I’ve got the
whole family prepared, and that’s what you have to do when you have
cancer. Things are going well one minute, but you never know when
they’re going to change.” —Gwen
27

33.
People Close to You
Often, talking with someone close to you is harder than talking with anyone else. Here’s some
advice on talking with loved ones during tough times.
Spouses and Partners
n Try as much as you can to keep your relationship as
it was before you got sick.
n Talk things over. This may be hard for you or your
spouse or partner. If so, ask a counselor or social
worker to talk with both of you together.
n Be realistic about demands. Your spouse or partner may feel guilty about your illness. They
may feel guilty about any time spent away from you. They also may be under stress due to
changing family roles.
n Spend some time apart. Your spouse or partner needs time to address their own needs.
If these needs are neglected, your loved one may have less energy and support to give.
Remember, you didn’t spend 24 hours a day together before you got sick.
n Body changes and emotional concerns may affect your sex life. Talking openly and
honestly is key. But if you can’t talk about these issues, you might want to talk with a
professional. Don’t be afraid to seek help or advice if you need it.
Children
Keeping your children’s trust is very important at this time. Children can sense when things
are wrong. So it’s best to be as open as you can about your cancer. They may worry that they
did something to cause the cancer. They may be afraid that no one will take care of them. They
may also feel that you are not spending as much time with them as you used to. Although you
can’t protect them from what they might feel, you can prepare them for these feelings.
Some children become clingy. Others get into trouble at school or at home. It helps to keep the
lines of communication open. Try to:
n Be honest. Tell them you are sick and that the doctors are working to make you better.
n Let them know that nothing they did or said caused the cancer.
And make sure that they know that they can’t catch it from you.
n Reassure them that you love them.
n Encourage them to talk about their feelings.
n Tell them it’s okay to be upset, angry, or scared.
n Be clear and simple when you talk, since children can focus only
briefly. Use words they can understand.
n Let them know they will be taken care of and loved.
28
n Let them know that it’s okay to ask questions. Tell them that you will answer them as
honestly as you can. In fact, children who aren’t told the truth about an illness can become
even more scared. They often depend on their imagination and fears to explain the
changes around them.

34.
Teenagers
Teenagers have some of the same needs as those
of younger children. They need to hear the truth
about an illness. This helps keep them from feeling
needless guilt and stress. But be aware that they
may try to avoid the subject. They may become
angry, act out, or get into trouble as a way of
coping. Others simply withdraw. Try to:
n Give them the space they need. This is
especially important if you are relying on
them more to help with family needs.
n Give them time to deal with their feelings,
alone or with friends.
n Let them know that they should still go to
school and take part in sports and other
fun activities.
If you have trouble explaining your cancer, you
might want to ask for help. A close friend, relative,
healthcare worker, or trusted coach or teacher
could help answer your teenager’s questions. Your
support group, social worker, or doctor can also
help you find a counselor or psychologist.
When a Parent Has Cancer
“My illness became a vehicle for
teaching my children lessons I’d want
to teach them if I’d never been sick.
Instead of fighting or trying to hide
all the challenges, I used them to
teach my kids the value of delayed
gratification, how to find hope when
the chips are down, that you are
the same person inside even if your
appearance changes, and that you try
your best and forgive yourself if things
don’t go well.
“My treatments became a powerful
way to say to my children, ‘I love you
and will do whatever I must to be
with you.’” —Wendy Harpham, M.D.,
author of When a Parent Has Cancer:
A Guide to Caring for Your Children
Adult Children
Your relationship with your adult children may change now that you have cancer again. You
may have to rely on them more. And it may be hard for you to ask for support. After all, you
may be used to giving support rather than getting it.
Adult children have their concerns, too. They may start to think about their own mortality.
They may feel guilt, because of the many demands on them as parents, children, and
employees. Some may live far away or have other duties. They may feel bad that they can’t
spend as much time with you as they would like. Often it helps to:
n Share decision-making with your children.
n Involve them in issues that are important to you. These may include treatment choices,
plans for the future, or activities that you want to continue.
n If they aren’t able to be there with you, keep them updated on your progress.
n Make the most of the time you have. Share your feelings with them.
Try to reach out to your adult children. Openly sharing your feelings, goals, and wishes will
help them adjust. It will also help prevent problems in the future. Remember, just as parents
want the best for their children, children want the best for their parents. They want to see your
needs met effectively and with compassion. Your children don’t want to see you suffer.
29

35.
“I really struggled with my diagnosis.
I couldn’t understand why I had to go
through this one more time. Although I
wouldn’t consider myself religious, I found
that prayer helped me. I began to feel as if
I had a purpose in life, and that the cancer
was just part of the plan.” —Bill

36.
chapter 8
Looking for Meaning
At different times in life, it’s natural for people to look for meaning in their lives. And many
people with recurrent cancer find this search for meaning important. They want to understand
their purpose in life. They often reflect on what they have gone through. Some look for a sense
of peace or a bond with others. Some seek to forgive themselves or others for past actions.
Some look for answers and strength through religion or spirituality.
Being spiritual means different things to different people. It’s a very personal issue. Everyone
has their own beliefs about the meaning of life. Some people find it through religion or faith.
Some find it by teaching or through volunteer work. Others find it in other ways. Having cancer
may cause you to think about what you believe—about God, an afterlife, or the connections
between living things. This can bring a sense of peace, a lot of questions, or both.
You may have already given a lot of thought to these issues. Still, you might find comfort by
exploring more deeply what is meaningful to you. You could do this with someone close to
you, a member of your faith or spiritual community, a counselor, or a trusted friend. Or you
may find that talking to others at gatherings and services at places of worship is helpful.
Or you may just want to take time for yourself. You may want to reflect on your experiences
and relationships. Writing in a journal or reading also helps some people find comfort and
meaning. Others find that prayer or meditation helps them.
Many people also find that cancer changes
their values. The things you own and your
daily duties may seem less important. You may
decide to spend more time with loved ones
or helping others. You may want to do more
things outdoors or learn something new.
31

37.
“I’ve been through this
once, and I’ll get through
it again. I wish I didn’t
have to, but that’s the
challenge before me.”
—Janet

38.
chapter 9
A Time To Reflect
This is a hard time in your life. Living with cancer is tough, especially when it has come back.
You battled the disease once, and now you must face it again. But you’re more experienced
this time around.
Use this knowledge to your advantage. Try to remember what you did before to cope. Reflect
on what you might have done differently. By looking back in this way, the hope is that you may
find new strength. And that this strength can help carry you through each day, and through the
coming weeks and months.
“Think only of today,
and when tomorrow comes,
it will be today,
and we will think about it.”
—St. Francis de Sales
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39.
Words To Know
Acupuncture (AK-yoo-PUNK-cher): A form of Chinese medicine that stimulates certain points
on the body. It is often done using thin needles. Before using acupuncture, ask your health care
team if it is safe for your type of cancer.
Advance directives: Legal documents that allow you to decide ahead of time how you want
to be treated when you are unable to speak for yourself. The two main types are living wills and
durable power of attorney for health care.
Biofeedback: Using a special machine, a person learns how to control certain body functions.
Examples of such body functions are heart rate and blood pressure.
Biological (bye-uh-LAHJ-uh-kul) therapy: Treatment that aims to use or restore the body’s own
immune (defense) system. It is used to fight cancer, infections, and other diseases. It is also used
to reduce the side effects that some cancer treatments cause. Also called immunotherapy.
Breakthrough pain: Pain that is sudden and intense or that is very painful for a short time. It
can occur several times a day. This can happen even when a person is taking the right dose of
pain medicine.
Cancer: A term for diseases in which abnormal cells divide out of control. Cancer cells can
invade nearby tissues and spread through the bloodstream and lymphatic system to other parts
of the body.
Chemotherapy (kee-moh-THAIR-uh-pee): Treatment with drugs that kill cancer cells.
Clinical trial: A type of research study that tests new methods of screening, prevention,
treatment, or diagnosis of a disease. Also called a clinical study.
Complementary and alternative medicine (CAM): Treatment used along with, or instead of,
standard health care. CAM includes methods such as acupuncture and massage. Some CAM
treatments may help relieve cancer symptoms or side effects. But not all CAM treatments are
safe. And they should not take the place of standard health care.
Diagnosis (dye-ug-NOH-sis): The name and details of your disease or health condition.
Dietitian (dy-uh-TIH-sun): A person with special training in nutrition, who can help you with
choices in your diet. They also can suggest ways to make eating easier.
Distant cancer: Cancer that has spread from the primary tumor to distant organs or lymph nodes.
34
Durable power of attorney for health care: This type of advance directive appoints a person
(a health care proxy) to make medical decisions for you when you can’t make them for yourself.

40.
Health care proxy: The person you have named in an advance directive to make medical
decisions for you. This person can make health care choices for you when you can’t make them
for yourself.
Health psychologist: A mental health professional who works with people and families affected
by illness.
Hypnosis: A state of relaxed and focused attention. The person focuses on a certain feeling,
idea, or suggestion.
Imagery: A method in which a person focuses on positive images in their mind.
I.V.: Short for intravenous (in-truh-VEE-nus). It means to get medicine or nutrients into the
body through a vein.
Living will: A type of advance directive. A living will is a legal document that lets people know
what kind of medical care you want if you are unable to speak for yourself.
Local cancer: Cancer that appears only in the organ where the cancer began. It has not spread
beyond the original site.
Lymph (limf) nodes: Small, bean-shaped organs that are part of the lymphatic system.
Bacteria or cancer cells that enter the lymphatic system may be found in the nodes. Also
called lymph glands.
Massage therapy: Gentle rubbing of different body parts or muscles to help you relax and gain
a sense of well-being.
Metastasis (meh-TASS-tuh-sis): The spread of cancer from one part of the body to another.
Cells that have metastasized are like those in the original tumor.
Notary public: A person with authority from the courts to witness legal documents and
signatures.
Oncologist (ahn-KAH-luh-jist): A doctor who specializes in treating cancer.
Oncology social worker: A social worker who specializes in helping cancer patients and
their families.
Palliative (PAL-ee-yuh-tiv) care: Care to improve the quality of life of people with a serious or
life-threatening illness. The goal of palliative care is to prevent or treat as early as possible:
• Symptoms of the disease
• Side effects caused by treatment
• Psychological, social, and spiritual problems related to the disease or its treatment.
Also called comfort care, supportive care, and symptom management.
35

41.
Power of attorney: Appoints a person to make financial decisions for you when you can’t make
them yourself.
Radiation (ray-dee-AY-shun) therapy: Treatment with high-energy radiation to kill cancer cells.
Recurrence (ree-KUR-ens): Cancer that has come back after a period of time during which it
could not be found. The cancer may come back to the same place as the original tumor or to
another place in the body. Also called recurrent cancer.
Recurrent cancer: See “recurrence.”
Regional cancer: Cancer that has grown beyond the original tumor to nearby lymph nodes or
organs and tissues.
Relaxation techniques: Different methods, such as deep breathing and relaxing the muscles,
that are used to reduce tension and anxiety and to control pain.
Second opinion: When you go to another doctor after getting a diagnosis. The second doctor
looks at your test results and examines you, just as the first one did. The second doctor may or
may not make the same diagnosis. And they may or may not recommend the same treatment.
Either way, you will have more information. This may help you decide on your treatment.
Specialist: A doctor who has studied and trained in a certain area of medicine.
Standard treatment: In medicine, treatment that experts agree is appropriate, accepted, and
widely used. Also called standard of care or best practice.
Surgery (SER-juh-ree): A medical procedure that involves entering or cutting into the body.
Surgery is used to remove or repair a part of the body or to find out whether disease is present.
Trust: This type of legal document appoints a person you choose to manage your money for you .
Tumor (TOO-mur): An abnormal mass of tissue.
Will: This type of legal document tells how you want to divide your money and property
among your heirs.
36

43.
n
U.S. Department of Labor Office of Disability Employment Policy
Provides fact sheets on a variety of disability issues, including discrimination, workplace
accommodation, and legal rights.
Phone:
1-866-633-7365
TTY:
1-877-889-5627
Visit:
www.dol.gov/odep/
Private/NonProfit Organizations
n
American Cancer Society
National Cancer Information Center
Available to answer questions 24 hours a day, 7 days a week.
Toll-free:
1-800-ACS-2345 (1-800-227-2345)
Visit:
www.cancer.org
n
CancerCare
Offers free support, information, financial assistance, and practical help to people with
cancer and their loved ones.
Toll-free:
1-800-813-HOPE (1-800-813-4673)
Visit:
www.cancercare.org
n
Cancer Support Community
Cancer Support Community is a national organization that provides support groups,
stress reduction and cancer education workshops, nutrition guidance, exercise sessions,
and social events.
Phone:
1-888-793-WELL (1-888-793-9355)
Visit:
www.cancersupportcommunity.org
n
Kids Konnected
Offers education and support for children who have a parent with cancer or who have lost a
parent to cancer.
Toll-free:
1-800-899-2866
Visit:
www.kidskonnected.org
38